Medical Consultant

About the Company

LUMA’s mission is to ensure our members live healthier, longer lives by providing them brilliantly simple insurance plans. We provide a range of simple, smart policies to global residents, expatriates, local nationals and groups of all sizes. At LUMA, we continuously adopt new innovations to make insurance easy to understand and easy to use.

Responsibilities

• Underwriting & Risk Assessment: Assess medical risk and provide recommendations on policy underwriting decisions; develop and maintain medical underwriting guidelines and criteria; support Sales and Operations teams in evaluating complex medical cases
• Claims Review & Governance: Review and validate medical claims for accuracy, necessity, and policy compliance; provide medical opinions on complex or disputed claims; approve or recommend denial of claims based on medical evidence; ensure consistency and fairness in claims decisions; manage meetings with members, treating doctors and partnered companies
• Medical Policy & Cost Management: Define and implement medical protocols, exclusions, and coverage guidelines; support cost containment strategies while maintaining quality of care; recommend appropriate treatment pathways for cost-effective care
• Knowledge Sharing within Teams: Deliver training to internal teams (Medical, Claims, Customer Service) on medical conditions and treatments, policy exclusions (e.g., dental, vision, pharmacy), and claims assessment principles
• Network & Provider Collaboration: Support the development of hospital and provider networks; provide input on provider quality and treatment standards; collaborate with network teams to optimize care quality and cost; develop relationships and agreements with senior hospital executives and key physicians in private and academic hospitals
• Compliance & Quality Assurance: Ensure adherence to medical ethics, regulations, and insurance policies; maintain confidentiality of medical information; stay updated on medical advancements and healthcare regulations

Qualifications

• Bachelor's degree in Medicine (M.D. or equivalent)
• Minimum 5 years of experience in medical practice and the health insurance industry
• Native English speaker preferred; other languages a plus

Benefits

• Competitive package
• 12 days of annual leave per year
• Social Security
• Provident Fund
• Medical Insurance